Health care initiative aims to ease wait times for Syrian refugees

New refugees from Syria, Sarkis Khoshafian and Sevan Khoshafian along with their sons Berj and Hagop Khoshafian receive settlement advice from Armenian Family Support Services workers Diana Zeynalvand and Rita Odjaghian at the Holy Trinity Armenian Church in Toronto on March 20, 2016.

At a clinic for Syrian refugees at Toronto's Women's College Hospital last month, a team of doctors met their first challenge: A family of 10, including eight restless, hungry children, stepped in for their first check-up.

A simple question, one of dozens – "Was your child immunized against measles?" – went through a series of steps. First, the question was input to a smartphone app, which translated the question for the patient in Arabic. The father, with limited Arabic knowledge, answered as best he could. The app translated it to English, and finally, the resident on hand could input the answer.

With more than 26,000 refugees already in the country, the potential bottleneck of casework for health-care providers is huge, and there is no easy way to integrate newcomers with already strained resources. It presents the kind of time crunch that clinics can't afford in the long term, especially in cities where the demand for interpreters outstrips their numbers.

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A new initiative by Canadian company CognisantMD hopes to reduce those waiting times. It has created a Syrian Refugee Medical Intake Tool, providing newcomers with a way to complete a full patient history and mental-health screening in their native tongue.

With the help of a simple online form, the patient can answer a series of questions in Arabic, Armenian or English. Their responses are then automatically translated to English and compiled into a full medical history, so that the physician can narrow in on specific health needs without the use of a professional interpreter.

It's a novel approach to helping newcomers integrate in a global crisis of this proportion, with millions of people displaced to places where their languages are not spoken but their health issues cannot wait.

"Some of them have not had health care in five years," explained Sharon Domb, a family physician with the Sunnybrook Academic Family Health Team that led February's clinic. "They have no idea what immunizations the kids have had, if any."

Dr. Domb said the team's members were lucky to have an Arabic-speaking resident on duty that day, but they normally go through a translation smartphone app, or call for a paid interpreter to facilitate the process.

"We're a teaching hospital at Sunnybrook, so because we were trying to allot an hour per patient, we're limited by the number of people that we have on staff," Dr. Domb said. "We had one supervising physician supervising three residents, each of whom could probably see three patients in a half-day."

CognisantMD co-founder Doug Kavanagh, whose Ocean tablets are already widely used in Canadian hospitals, wanted to provide a free tool for health-care providers across the country to address the needs of refugees.

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"These are people with unique needs, from a uniquely difficult situation," he said. "They have a cursory exam when they arrive in Canada, which has less to do with care, more to do with screening them for diseases like tuberculosis. But just like any other Canadian, they may have chronic diseases. These routine things need treatment like anything else."

A 2015 Statistics Canada study showed that language barriers play a part in self-reported long-term health for newcomers, who tend to arrive in better health than most Canadians, but experience a decline over their first four years here.

Dr. Kavanagh is confident that their care is a manageable problem, once clinicians get over the initial intimidation of its scope.

The tool was built with pro bono translation help from the likes of Faisal Al-Sani, a clinical fellow at Toronto's Hospital for Sick Children who helped sift through culturally irrelevant references as basic as "common-law marriage" or "eczema."

A native Arabic speaker, Dr. Al-Sani was moved by the Canadian welcome to refugees and decided that helping to build the tool would be his way of contributing.

He believes that overcoming cultural barriers to communicating more sensitive issues, such as details of sexual history or drug use, becomes a lot easier with a direct form, without bringing a third person into the loop.

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"I find that when you fill up a form, you lose that 'in-the-spotlight moment' that you sometimes get when asked a sensitive question in a usual face-face interaction," Dr. Al-Sani said.

Translation services were also provided by volunteers at the Armenian Family Support Services (AFSS), part of the Holy Trinity Armenian Church, which has processed almost 1,800 refugees in Toronto alone, many of whom suffer from hypertension, diabetes or serious dental-care issues.

Rita Odjaghian, chair of AFSS, believes that the tool will show its true advantage as refugees settle down in permanent housing, jobs and schools and long-suppressed mental-health issues begin to crop up.

"They talk about the fact that they have lost their houses in Syria. I had one saying that they left Syria, and in the bus they had a sniper going through. Or maybe sometimes the militants come and they ask them for money and they are still in fear. Or they were in jail, taken by the militants to do some repair work, and they weren't sure whether they would come out alive or they would be killed," Ms. Odjaghian said.

Despite a limited availability of Arabic-speaking or Armenian-speaking health-care professionals, she believes that the tool will help ease the transition significantly.

"One of our board members [pointed out] we need this for the Armenian-speaking population, not only for the refugees but also for the existing community," Ms. Odjaghian said. "If a patient goes into the emergency room and that information is available, it will be very good."

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